AAFP Throws Support Behind Smoke-free Public Housing Proposal

Academy, Other Stakeholders Offer Recommendations for Improvement

According to recent CDC data,(www.cdc.gov) the prevalence of cigarette smoking among U.S. adults declined from almost 21 percent in 2005 to less than 17 percent in 2014. Even so, smoking remains the leading cause of preventable disease and death in the United States, accounting for about 480,000 premature deaths each year.

Moreover, although secondhand smoke exposure among adults and children has been cut in half(www.cdc.gov) in the past 15 years, 58 million nonsmokers were exposed to secondhand smoke in 2011-2012. Rates of exposure are highest among children, blacks, people living in poverty and those who rent their housing.

In a Jan. 13 letter, AAFP Board Chair Robert Wergin, M.D., of Milford, Neb., made a point of expressing appreciation for the chance to attend the White House Smoke-Free Housing Summit HUD and HHS jointly convened earlier this month. The summit, he noted, provided a valuable opportunity to discuss the health and economic benefits of the proposed rule, including the fact that it stands to impact 2 million people and could save an estimated $153 million in health, safety and facility damage costs.

"We … applaud HUD for taking this important step that will create additional smoke-free environments," said Wergin. "This historic step will help protect the public health, especially that of children, in our nation's most vulnerable populations."

In addition to prohibiting smoking in all indoor areas of public housing properties covered by the proposed rule, the draft regulation would establish a 25-foot nonsmoking buffer zone from all doors, windows and ventilation intakes to prevent secondhand smoke from outside the building drifting back into living areas, as well as to ensure people don't have to wallow through clouds of secondhand smoke when they enter or exit the building.

Wergin's letter did call for improvements to the proposed rule, however. "We call on HUD to include in the final rule the exclusion of electronic nicotine delivery systems (ENDSs) and waterpipe tobacco (hookahs) in restricted areas and that the regulation should apply to all government-subsidized housing rather than just all government-owned housing."

Finally, Wergin urged the department to include a provision in the final rule that would compel government-subsidized housing authorities to refer residents to Quit-line services,(smokefree.gov) basing this recommendation on evidence that shows "combining FDA-approved quit smoking therapies with counseling services are the most effective for successful quit attempts."

And the Academy's advocacy on this issue didn't stop there. In a Jan. 19 letter(20 page PDF) spearheaded by the Campaign for Tobacco-Free Kids, the AAFP joined three dozen other organizations in strongly supporting the proposed rule, calling it "a major step forward in protecting the millions of Americans who currently live in federally owned public housing from the harms of tobacco."

In their letter, the groups reiterated the AAFP's call for improvements to the rule, such as prohibiting use of ENDSs and other types of nicotine-dispensing devices in addition to combustible cigarettes and applying the rule to all government-subsidized housing.

Furthermore, said the joint letter, "Our organizations also strongly urge HUD to prohibit any 'grandfathering' policies that delay implementation beyond the 18-month period (the department has proposed) or allow case-by-case decisions that would allow some smokers to still smoke indoors.

"A mandatory policy that applies to everyone from the beginning of the policy is the only way to ensure everyone can breathe clean, safe air in their homes and achieve health benefits."